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General NPI Number Information
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NPI Number | 1073654950
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Entity Type | Organization
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Legal Business Name | ALL AGES MEDICAL CARE, PLLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 2 MEDICAL PARK DR SUITE 5
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City | WEST NYACK
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State | NY
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Zip | 10994-1965
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Country | US
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Telephone | 845-535-3007
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MEDICAL PARK DR SUITE 5
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City | WEST NYACK
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State | NY
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Zip | 10994-1965
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Country | US
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Telephone | 845-535-3007
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JAY LORAH
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Credential | D.O.
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Telephone | 845-535-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2067871
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License Number State | NY
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